Serving the public by regulating physicians and surgeons

Updates from the Non-Hospital Medical and Surgical Facilities Program

Skin preparation—a collaborative effort

Special care and attention must be taken to prevent injury such as chemical burns to a patient during surgical skin preparation, especially when prepping areas such as the face, eyes and ears or mucous membranes.

Selecting an appropriate skin preparation is a collaborative effort, which requires both surgeons and perioperative nurses alike to be knowledgeable in the selection process, including awareness of any contraindications and/or special precautions. The surgical site prep solution used should also be reviewed during the briefing period of the surgical safety checklist with all members of the surgical team present.

The surgical skin preparation is documented on the perioperative record, and must include the condition of the skin if other than healthy and intact, name and concentration of prep solution used, any skin reaction that occurred, and the name of the person performing the skin prep.

Note: Incidents that result in a harmful or undesired effect to the patient, whether or not the risk or hazard was averted, must be reported to the College in accordance with the Bylaws.

For more information, registrants should refer to the Operating Room Nurses Association of Canada (ORNAC) Standards for Perioperative Registered Nursing Practice and the Association of periOperative Registered Nurses (AORN) Perioperative Standards and Recommended Practices for further information on surgical skin preparation.

CPR for health-care providers

Physicians and dentists who perform surgery or procedures in a non-hospital facility and all clinical staff at the facility, e.g. nurses, refractive assistants, must hold current Basic Life Support for Healthcare Providers (BLS HCP) training.

Education providers of BLS HCP training are issuing training certificates with expiry dates ranging from one to three years from the date of completion of the training course; however, an expiry date of one year is becoming more common. The NHMSFP Committee has decided the following:

that current BLS HCP will be based upon the date of completion of the training course and not the expiry date on the certificate; and

that BLS HCP must be completed every two years from the date of the training course.

Anesthesia Laerdal Trachlights™ must be removed

In September 2009, Laerdal announced that they had discontinued their Trachlights™, Stylets and Tracheal Lightwands. Laerdal further advised that Trachlights™ (handles, wands and starter kits) not be kept for more than three years due to the material properties and lifetime expectancy. With three years now past, registrants should take action to remove Trachlights™ from non-hospital facilities.

In addition to basic intubation equipment, all Class 1 facilities must have at minimum two alternative methods for difficult airway intubation and management. Alternative intubation methods are left to the clinical judgment and preference of the anesthesiologist(s) working at the facility. Suggestions include but are not limited to: LMA Fastrack, glidescope, Light Wand™ (not to be confused with the Trachlight™), McCoy curved laryngoscope.

Providing a latex-safe environment

Non-hospital facilities are required to provide a latex-safe environment for patients with a known or suspected latex allergy. Registrants are reminded of the importance of identifying patients with food allergies and/or sensitivities that may suggest a latex allergy as outlined in the NHMSFP accreditation standard: Latex Allergy. Latex cross-reactivity foods include but are not limited to: bananas, avocados, chestnuts, apricots, kiwis, papayas, passion fruit, pineapples, peaches, plums, cherries, melons, figs, grapes, potatoes, tomatoes, celery, apples, pears, carrots, hazelnuts, wheat, rye, molds and pollen. Further information on cross-reactive foods can be found at American Latex Allergy Association.

Allergies and reactions need to be up to date and the information shared with all health-care professionals. As a final check, allergies and reactions must be discussed by the surgical team during the briefing period of the surgical safety checklist before proceeding with the surgery.

Flooding may pose risk to patient safety

Flooding in a health care facility poses a potential threat of infection to current and future patients, therefore, flooding of a non-hospital facility must be immediately reported to the College and scheduled surgeries may potentially be cancelled. The non-hospital facility must retain a certified infection, prevention and control (ICP) consultant to immediately assess the situation, direct the facility and restoration team on the remedial measures, and provide written confirmation when the potential threat of infection has been effectively mitigated. The ICP reports must be submitted to the College for review and the non-hospital facility may not recommence surgery until final approval has been granted by the College.

The Non-Hospital Medical and Surgical Facilities Program requires private facilities to maintain high standards of practice equal to or exceeding public hospitals. The program establishes accreditation and performance standards, procedures and guidelines to ensure the delivery of high quality health services. The 700 physicians who work in private facilities across the province must be granted privileges by the College.